Science takes aim at the swine flu
The world's response to the outbreak shows progress and problems: Scientists have more tools, but early detection remains difficult in some places.
Governments confronting a new strain of swine flu from Mexico have an unprecedented set of scientific tools to help them. The result is steady improvement in dealing with outbreaks like the current one.
Yet experts say a lack of clear communication in Mexico about the status of the outbreak and what people could do to protect themselves was perhaps a major factor in how the strain spread throughout the country and the world.
In the US, public-health officials said Monday they have identified 40 cases, with one person hospitalized. But "things are working well, from what I can see," says Peter Hotez, who heads the department of microbiology, immunology, and tropical medicine at George Washington University in Washington.
The faster speed of communications helps: Word of a problem gets out much more quickly than it did 20 years ago. But science, too, has improved its ability to identify an illness's origins, assess its susceptibility to existing vaccines, and model the trajectory the outbreak could take, experts say.
Researchers say they have increased their capacity to recognize and understand the nature of the biological agents involved. Even six years ago in the case of SARS, scientists needed only a relatively short time – six weeks – to characterize the agent involved, says Myron Cohen, director of the University of North Carolina's Institute of Global Health and Infectious Diseases. And SARS was something no one had seen before. Previously, that process might have taken years.
As for the outbreak of illness in Mexico: "Look how quickly we understood that it was an influenza agent, which in many ways is reassuring," Dr. Cohen says. "The ability to gain information on the agent and its pedigree is really quite remarkable."
Moreover, there are more labs and equipment that can do the work. When US labs reportedly required extra paperwork to analyze samples of the flu agent, public-health officials in Mexico simply sent the samples to labs in Canada. In California, the first diagnosed cases of swine flu from the Mexican outbreak were uncovered by researchers developing new test kits physicians could use in their offices, according to Richard Besser, acting director of the Centers for Disease Control and Prevention (CDC) in Atlanta during a briefing Monday.
In the US, officials already have started moving vaccines out of stockpiles and to healthcare providers. At this point, the CDC has released about 25 percent of that stockpile.
If the outbreak becomes more serious than it currently appears, Dr. Besser says, "doctors will have what they need."
For all the technological progress, however, more needs to be done, say some specialists.
Though the technology now exists to respond quickly – reducing the time it takes to design and evaluate a new or modified vaccine, it will take money to put the technologies in place, says Dr. Hotez.
Early detection remains an issue in some parts of the world, as well. The outbreak's origins in Mexico, for example, are largely a mystery. "We do not know how long this virus has been circulating and capable of human-to-human transmission," says Ted Cohen, an assistant professor of medicine at Brigham and Women's Hospital in Boston. "Certainly, the wide geographic distribution of cases indicates that our detection systems were not able to contain the virus where it initially emerged."
"This delay undoubtedly has limited our ability to respond to this potential crisis with travel restrictions or others methods that might have potentially prevented the long-distance spread of this pathogen," he adds.
Lessons from the past also show clearly that keeping people well-informed and apprised of developments is the best thing to do. "But it's not a lesson all governments have learned," says David Ozonoff, a communicable-disease specialist at Boston University.
He points to Mexico, which, he says, has been "authoritarian on one hand and not very informative on the other" with the public. The situation is compounded by a general lack of public trust in anything government officials say, he adds.
The United Nations' World Health Organization (WHO) generally has done a good job responding to the outbreak, Dr. Ozonoff says, but has underplayed the outbreak's severity. During the weekend, it hovered at 3 on the agency's 1-to-6 scale – even when it was clear by the scale's definitions that the outbreak was a 4 or 5, he says. "There are consequences" to higher ratings, he says, which include trade and travel restrictions. Today, the WHO raised the severity of the outbreak to Level 4.